Over the past six months, Ive been receiving provocative DMs from a famous plastic surgeon.
Its as if hes building a case, with Instagram as his richest source of discovery.
Much of what this surgeon shares are unreliable before-and-after images, engineered to elevate the results theyre promoting.
Getty Images
Beware the surgeon who isnt fastidious enough to take consistent photos, he warns.
It shows they are lazy, not careful, or intending to manipulate you.
It is during the first minute of the healing process).
These concerns are valid and backed by data.
New additions to the category of after enhancements aresemaglutide(a.k.a.
And the doctors posting images of these metamorphoses rarely point out the influence of Ozempic on the surgical result.
Patients are carefully posed at a prescribed distance from the lens and captured from multiple angles.
Backdrops (solid, matte) and lighting (bright, balanced) are identical.
Nothing distracts from the transformation that is being documented not hair, makeup, clothing, or jewelry.
Nonsurgical treatmentsshould adhere to the same established standards that exist for surgical procedures, says Dr. Soares.
The Rise of Deceptive Before-and-After Photos on Social Media
Whats behind the sharp uptick in illusory images?
Many attribute it to the unrelenting nature ofsocial mediaand the 24/7 pressure to produce grabby content.
Thats why we get so many on-tables.
Its like, This will be cool to show right now, today.
No one puts on-table results on their website, Dr. Pittman says.
In those galleries, theres almost an expectation of standardization.
Patient selfies, on the other hand, tend to trigger less flags.
Somebody who posts a selfie that a patient sent them is not.
Its the best thing Ive ever done on Instagram, says Dr. Pittman.
Ninety percent of my patients fly in and out for surgery, says Dr.
According to Dr. Soares, that logic holds.
Social media tends to amplify and disseminate content that has entertainment value, he explains.
And as dramatic before-and-after comparisons elicit a greater response from viewers, poor-quality photos tend to spread much faster.
Few surgeons show complications, disgruntled patients, or even average results.
And routinely, those exemplary outcomes are being manipulated to sell more procedures and get more clicks.
How is anyone supposed to compete with this jot down of marketing?
You dont take the before and after so you have something to show on Instagram, Dr. Teitelbaum says.
These pictures have long served an educational purpose.
Patient photographs were quickly adopted to document and study results.
The only way we can monitor and assess these things is with standardized photos, says Dr. Roostaeian.
Anything short of that is nonsense.
Meticulous surgeons still use B&As to scrutinize their outcomes and fine-tune techniques.
Each time, I glean something to improve my results, he says.
From the patients point of view, before-and-after photos are vital to managing expectations.
Theyre meant to express what can be done, accurately and truthfully, says Dr. To sidestep this scenario, some physicians ask patients to constructvision boardsusing only standardized photos from their own websites.
Straight-on lighting tends to be most realistic, but Dr.
Chance frequently sees after faces lit from below.
The same can be said for overly bright lighting.
Certain lighting changes can be detected in the subjects eyes.
Likewise, if the pupils are wider in the before image, thats usually due to dimmer lighting.
(These reflections, or highlights, are called catchlights; without them, the eyes look dull.)
Black-and-white B&As are also suspect.
Not only are they intrinsically more flattering, they conveniently minimize fresh surgical scars by blanching their color.
Be suspicious of shifting facial expressions and body parts.
This elongates the neck and jawline and overstates the power of surgery.
Pay attention to arm position too.
Says Dr. Pittman, Everyone looks thinner with their arms up in the air.
Facial expressions can dramatically alter the appearance of results.
Even without surgery, smiling can lift the cheeks and minimize jowls, notes Dr.
Chance, so people should wear neutral expressions in B&As.
In a facelift before photo, you might notice that the patient looks a little bit mournful, Dr.
Chance says, due to the downward direction of the mouth and jowls.
But following a facelift, some people look happy even without smiling, she adds.
When youre comparing two pictures, see to it the gaze is consistent.
Some surgeons look past it, recognizing that patients are sometimes reluctant to remove makeup for midday photo shoots.
Hairstyles should be alike in B&As.
The oblique view tends to be most forgiving.
Other doctors say outcomes are mostly stable by three or four months.
Nonsurgical treatments follow a different timeline.
Nevertheless, many ignore the two-week rule.
Given that selfies are not standardized and can be edited orfiltered we cant compare them to clinical before pictures.
Selfies may hold more value as testimonials, rather than as authentic afters.
The confidence they exude is palpable, and it helps others relate to them.
But, again, patient selfies shouldnt comprise the bulk of photos on a surgeons grid.
Plastic surgeons are split on the virtues of video.
But with a high-resolution, well-lit still photo, any little deformity is glaring, he says.
I mean, what can I hide?
(Hes referring to nose jobs, primarily.)
The Bottom Line on Before-and-Afters
Before-and-after images advertise more than outcomes they disclose a doctors values.
Theyre how you judge the work and how you judge whos going to be truthful with you, Dr.
Consistent clinical photos are the gold standard.
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